Look Beyond the Pelvic Floor – Pediatric Pelvic Health

Dawn Sandalcidi PT, RCMT, BCB-PMD is known as the go-to expert in the field of pediatric pelvic health. She has been practicing for 40 years this May and has concentrated on the pediatric pelvic floor for 29 of those. When it comes to pediatric pelvic floor issues, there is so much more than bedwetting, and often the practitioner needs to look beyond the pelvic floor.

Despite the growing number of pelvic rehab specialists treating men and women with PF dysfunction, children in this patient population remain woefully under-served. This can cause undue stress for the child and family, as well as the development of internalizing and externalizing psychological behaviors. Many of the techniques used in pediatric pelvic therapy can be translated to the adult population. The question is ‘who’s the driver?’ In pediatrics, it is typically a bowel issue.

The Standard American Diet involves food that is high in calories, saturated fats, trans fats, added sugars, and sodium. It is also lacking in the intake of essential nutrients for the body like fiber, calcium, potassium, and vitamin D. This lack of dietary fiber can cause issues with the digestive tract as well as the colon leading to constipation. Bowel dysfunction including constipation can contribute to urinary leakage and urgency (1). Constipation accounts for approximately 5% of visits to pediatric clinics (2) proving that there is a need for practitioners to know how to treat these pediatric issues.

Dawn focuses much of her pediatric knowledge on her two courses: Pediatric Incontinence and Pelvic Floor Dysfunction (PEDs) and Pediatric Gastrointestinal Disorders (PEDsG). Pediatric pelvic floor basics are covered in PEDs, including instruction in anatomy, physiology, development of normal voiding reflexes and urinary control, and learning how to talk with child patients. Biofeedback and ultrasound (which Dawn fondly calls jelly belly) are also covered and can be helpful as less invasive procedures for children.

PEDsG goes beyond the pelvic floor and opens up the door to look at the big picture of the whole child. Dawn shares that almost 80% of her kiddos with chronic constipation present with diastasis rectus abdominus. They can also have hyperextension in the thoracic spine, and the rib cage is postally rotated – where the kids don’t know how to bring it down.

Dawn is also on the threshold of writing a pediatric pelvic pain course that she expects to be ready later this year. Pediatric pelvic pain is becoming more prevalent, and it can’t be treated the same way as in adults. Dawn explains that “children don’t understand, so we’re actually creating a pediatric pain neuroscience protocol. It is a bio-psycho-social approach, and we use fun things.”

Research tells us that 15% of kids per year will outgrow bedwetting. Children who suffer from bedwetting can feel ashamed and embarrassed, have self-esteem issues, or even act out. There are 5 basics of where you start with a pediatric patient that are taught in PEDs. Dawn also shares 5 basics in her e-book, BEDWETTING BOOTCAMP(3):

1. Avoid things that can irritate the bladder
2. Avoid drinking anything just before bed
3. Drink throughout the day
4. Empty your bladder throughout the day
5. Avoid constipation and straining

Everything in Pediatric Incontinence and Pelvic Floor Dysfunction builds into Pediatric Gastrointestinal Disorders, and everything in PEDsG builds into Pediatric Pelvic Pain. The more practitioners who learn about the pediatric pelvic floor means that more kids get treated and the fewer adults that will have pelvic floor dysfunction. To learn more about treating pediatric pelvic health register for one of Dawn Sandalcidi’s upcoming courses:

Pediatric Incontinence and Pelvic Floor Dysfunction: August 27-28th

Pediatric Gastrointestinal Disorders: May 14-15, November 12-13

References:

1. Sandalcidi (Spring 2018). Paediatric incontinence and pelvic floor dysfunction. Journal of Pelvic, Obstetric and Gynaecological Physiotherapy, 122, 5–8.
2. Thibodeau B. A., Metcalfe P., Koop P. & Moore K. (2013) Urinary incontinence and quality of life in children. Journal of Pediatric Urology 9 (1), 78–83.
3. Dawn Sandalcidi PT, RCMT, BCB-PMD. BEDWETTING BOOTCAMP Frustrated by Bed Wetting? The 5 Ways to Speed Starting Up Dry Tonight! www.kidsbowelbladderPMD.com. https://cdn.fs.teachablecdn.com/YfP5rUfiRtOJxXZSZUso